CurrentUnitedHealthcarePolicy 2025 P 1325-6

Reyvow (lasmiditan) prior authorization and coverage criteria

Defines UnitedHealthcare Pharmacy prior authorization/notification criteria for Reyvow (lasmiditan) for the acute treatment of migraine in adults, including initial authorization, reauthorization, and program notes affecting supply limits, step therapy, and automated approvals.

Policy Summary

PayerUnitedHealthcare

PolicyReyvow (lasmiditan) prior authorization and coverage criteria

Policy CodePolicy 2025 P 1325-6

Change TypeAnnual review — no material changes

Effective DateJun 1, 2025

Next Review Date

Key ActionSubmit prior authorization requests and document positive clinical response for reauthorization to support approval under the stated criteria.

SourceLink

POLICY UPDATE CHANGES

Annual reviews occurred through 3/2025; most recent entries note 'No changes' for 3/2024 and 3/2025.

12Authorization duration for initial and reauthorization

18+Minimum patient age for coverage

1Indication required: migraine with or without aura

Supply limits/PA/StepMay apply (program constraints)

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Initial Authorization (Medically Necessary)

Reyvow will be approved when ALL of the following are met:

ALL of the following

Diagnosis of migraine headaches with or without aura
Used for acute treatment of migraine
Patient is 18 years of age or older

Reauthorization (Continuation Therapy)

Reyvow will be approved for reauthorization when the following is met:

ALL of the following

Documentation of positive clinical response to therapy
Positive clinical response: Documentation that the patient derived clinical benefit from Reyvow as determined by the treating clinician (no explicit numeric threshold provided).

What Providers Must Do

Prior Authorization

Prior authorization/notification required

Prior authorization or notification program applies for Reyvow; approval is based on meeting the stated clinical criteria and may be influenced by claim/medication history and diagnosis coding.

Approval is contingent on meeting the clinical criteria specified in the policy (diagnosis of migraine, acute use, age ≥18).
UnitedHealthcare may use claim/medication history, diagnosis codes, and automated processes to influence approval.

Documentation Required

Document response for reauthorization

For reauthorization, providers must document a positive clinical response to therapy to qualify for continued coverage; reauthorizations are issued for 12 months when this documentation is provided.

Positive clinical response is determined by the treating clinician (no numeric threshold specified).

Denial Risk

Denial risk if criteria not met

Requests that do not meet all initial authorization criteria or lack documentation of response at reauthorization risk denial; state mandates and member-specific benefit plans may further impact coverage.

Initial criteria include diagnosis of migraine, use for acute treatment, and patient age ≥18.
A State mandates and member benefit plans may alter coverage decisions.

Step Therapy

Step therapy may apply

Step therapy requirements may apply under this program; the policy references American Headache Society recommendations (e.g., prior use of NSAIDs, non-opioid analgesics, or migraine-specific agents) as contextual guidance and programs may enforce step edits.

AHS recommends NSAIDs or non-opioid analgesics for mild–moderate attacks and migraine-specific agents (triptans, DHE) for moderate–severe attacks or inadequate response.
Program step edits may require prior use of these agents before Reyvow is approved.

Prior Authorization

Supply limits and automated approvals

Supply limits may apply and UnitedHealthcare may approve initial and reauthorization based solely on prior claim/medication history, diagnosis codes, and/or claim logic using automated processes.

Use of automated approval and re-approval processes varies by program and therapeutic class.
Supply limits and prior authorization–medical necessity programs may also apply.

Clinical and Program Context

Reyvow (lasmiditan) is a serotonin 5-HT1F receptor agonist indicated for the acute treatment of migraine with or without aura in adults. The American Headache Society recommends attempting NSAIDs (including aspirin), non-opioid analgesics, acetaminophen, or caffeinated analgesic combinations for mild-to-moderate migraine attacks and using migraine-specific agents (e.g., triptans, dihydroergotamine [DHE]) for moderate-to-severe attacks or for mild-to-moderate attacks that respond poorly to NSAIDs or caffeinated combinations.

Policy Changes

2025-03clarifiedLatest

Annual review conducted in March 2025; document notes 'No changes' compared with the prior review.

2024-03clarified

Annual review conducted in March 2024; document notes 'No changes.'

2023-03clarified

Annual review conducted in March 2023; references were updated.

2022-03clarified

Annual review conducted in March 2022; references updated.

2021-07clarified

Program update in July 2021: annual review with updated references and added state mandate language.

2020-08clarified

Program created (new prior authorization-notification program established in August 2020).

OpenPayer

Reyvow (lasmiditan) prior authorization and coverage criteria

Medical Necessity Criteria

What Providers Must Do

Relevant Codes

Clinical and Program Context

Defined Terms

Policy Changes

At-a-Glance Policy Metrics